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A recipient is eligible to receive services under the GUIDE Model if they meet the following criteria: Has dementia, as confirmed by attestation from a clinician on the GUIDE Individual's GUIDE Practitioner Roster; Is enrolled in Medicare Components A and B (not enrolled in Medicare Benefit, consisting of Unique Requirements Plans, or speed programs) and has Medicare as their main payer; Has actually not chosen the Medicare hospice advantage, and; Is not a long-lasting assisted living home local.

The table below programs a description of the five tiers. GUIDE Individuals will report data on illness phase and caretaker status to CMS when a beneficiary is first lined up to an individual in the design. To guarantee consistent beneficiary assignment to tiers across design participants, GUIDE Individuals must utilize a tool from a set of authorized screening and measurement tools to determine dementia phase and caregiver concern.

GUIDE Participants must inform beneficiaries about the design and the services that beneficiaries can get through the design, and they should document that a recipient or their legal agent, if relevant, authorizations to receiving services from them. GUIDE Participants should then send the consenting beneficiary's details to CMS and, within 15 days, CMS will confirm whether the recipient satisfies the model eligibility requirements before aligning the recipient to the GUIDE Participant.

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For an individual with Medicare to get services under the design, they should fulfill particular eligibility requirements. They will also require to find a healthcare company that is taking part in the GUIDE Design in their community. CMS will release a list of GUIDE Individuals on the GUIDE website in Summertime 2024.

For instant assistance, please find the following resources: and . You might also get in touch with 1-800-MEDICARE for particular info on questions regarding Medicare advantages. For the purposes of the GUIDE Model, a caretaker is defined as a relative, or unpaid nonrelative, who assists the beneficiary with activities of day-to-day living and/or crucial activities of day-to-day living.

People with Medicare need to have dementia to be qualified for voluntary alignment to a GUIDE Participant and may be at any stage of dementiamild, moderate, or severe. When an individual with Medicare is very first assessed for the GUIDE Model, CMS will rely on clinician attestation rather than the presence of ICD-10 dementia diagnosis codes on prior Medicare claims.

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Additionally, they may confirm that they have actually received a composed report of a recorded dementia diagnosis from another Medicare-enrolled specialist. As soon as a recipient is voluntarily lined up to a GUIDE Participant, the GUIDE Participant need to connect an eligible ICD-10 dementia medical diagnosis code to each Dementia Care Management Payment (DCMP) monthly claim in order for it to be paid by CMS.The approved screening tools include 2 tools to report dementia stage the Medical Dementia Rating (CDR) or the Practical Evaluation Screening Tool (QUICK) and one tool to report caregiver pressure, the Zarit Concern Interview (ZBI).

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GUIDE Participants have the option to seek CMS approval to use an alternative screening tool by submitting the proposed tool, in addition to released evidence that it is valid and reliable and a crosswalk for how it represents the model's tiering thresholds. CMS has complete discretion on whether it will accept the proposed alternative tool.

The GUIDE Model requires Care Navigators to be trained to deal with caregivers in recognizing and managing common behavioral modifications due to dementia. GUIDE Individuals will likewise assess the beneficiary's behavioral health as part of the detailed assessment and supply beneficiaries and their caregivers with 24/7 access to a care group member or helpline.

For example, an aligned beneficiary would be deemed disqualified if they no longer satisfy several of the recipient eligibility requirements. This might happen, for instance, if the beneficiary becomes a long-term assisted living home local, registers in Medicare Benefit, or stops receiving the GUIDE care delivery services from the GUIDE Individual (e.g., due to the fact that they move out of the program service location, no longer desire to be aligned to the GUIDE Participant, or can not be contacted/are lost to follow-up). The GUIDE Design is not a total expense of care model and does not have requirements around specific drug treatments.

GUIDE Participants will be enabled to revise their service area throughout the period of the Model. The GUIDE Individual will determine the beneficiary's main caretaker and examine the caretaker's understanding, requires, well-being, stress level, and other challenges, including reporting caretaker stress to CMS utilizing the Zarit Burden Interview.

The GUIDE Design is not a shared savings or overall cost of care model, it is a condition-specific longitudinal care model. In general, GUIDE Design individuals will be paid a month-to-month dementia care management payment (DCMP) for each beneficiary. The GUIDE Model is developed to be compatible with other CMS accountable care designs and programs (e.g., ACOs and advanced primary care models) that provide health care entities with chances to improve care and decrease spending.

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DCMP rates will be geographically adjusted in addition to a Performance Based Modification (PBA) to incentivize top quality care. The GUIDE Model will also spend for a specified amount of respite services for a subset of model recipients. Design individuals will utilize a set of new G-codes produced for the GUIDE Model to send claims for the regular monthly DCMP and the break codes.

Respite services will be paid up to an annual cap of $2,500 per recipient and will differ in unit costs reliant on the type of respite service utilized. Yes, the month-to-month rates by tier are offered below.(New Client Payment Rate)$150$275$360$230$390(Established Client Payment Rate)$65$120$220$120$215GUIDE Participants are accountable for paying Partner Organizations for GUIDE care delivery services that the Partner Organization supplies to the GUIDE Participant's lined up beneficiaries.

GUIDE Participants and Partner Organizations will determine a payment arrangement and GUIDE Participants must have contracts in place with their Partner Organizations to show this payment plan. GUIDE Participants will also be expected to maintain a list of Partner Organizations ("Partner Organization Lineup") and update it as modifications are made throughout the course of the GUIDE Model.